Enophthalmos-Volume & Location of Orbital Tissue Herniation

Enophthalmos-Volume & Location of Orbital Tissue Herniation Joseph Ta, MD (presenter) OBJECTIVE: To predict the possibility of enophthalmos and diplopia in orbital fracture by correlating soft tissue herniation and location of fracture with clinical outcomes. METHOD: Retrospective chart reviews of patients 16-60 from 1998-2008 seen at major Level I trauma medical center with orbital soft tissue herniation in orbital fractures. Patients with appropriate CT scan and clinical follow-up with Otolaryngology and Ophthalmology were included in the study. CT scans were reviewed and orbital soft tissue herniation were measured with radiological software. The location of the fractures were also identified and chosen to be one of five possible area drawn out on the orbital floor. RESULTS: Seventy-eight patients were identified for the study with appropriate follow-up, clinical exam and CT scan. Ages ranged from 16-58 years old (61 males, 17 females). Orbital soft tissue volume range from 0.5-2.8 cm3 (average 1.7 cm3). Most fractures involved the anterior and central floor of orbit. The critical volume for enophthalmos was determined to be 1.2 cm3. CONCLUSION: Soft tissue herniation of more than 1.2 cm3 and central floor fracture were highly predictive of enophthalmos and should consider early surgical intervention. Fluorescent Angiography in Head and Neck Reconstruction Christopher Dress, MD (presenter); Christian Hasney, MD OBJECTIVE: 1) Understand the fundamentals of intraoperative fluorescent angiography (FA); 2) Learn the potential numerous applications of fluorescent angiography in head and neck reconstruction, from local flaps to microvascular tissue transfer. METHOD: Intraoperative fluorescent angiography was performed on reconstructive patients cared for by 2 microsurgeons at a military hospital between March 2009 and February 2010. A retrospective analysis with descriptive statistics was accomplished on this early experience. RESULTS: Intraoperative fluorescent angiography with indocyanine green was successfully utilized in 12 reconstructive patients, including 4 patients with head and neck defects. Fluorescent angiography identified cutaneous perforators, assessed the patency of microvascular anastomoses, and determined viability of large skin paddles. In a novel application, FA clearly identified the extent of compromised native mandible in a patient with advanced osteoradionecrosis, which had been underestimated by preoperative imaging. This real-time data directly led to modifications of the operative plan in 3 patients. There were no complications and no complete flap losses in this early series.

P43 CONCLUSION: Intraoperative fluorescent angiography with indocyanine green is a recent addition to the reconstructive armamentarium. It complements the clinical acumen and experience of the surgical team, as well as existing technologies, to assess and predict tissue viability. For the first time, this technology has been used to assess the native mandible in osteoradionecrosis - precisely guiding osteotomies and the extent of resection. Further experience with fluorescent angiography will identify additional applications in the head and neck. Immediate Gold Weight at the Time of Facial Nerve Sacrifice Tammara Watts, MD, PhD (presenter); Rachel Chard; Stephen Weber, MD, PhD; Mark Wax, MD OBJECTIVE: 1) Understand the benefits of immediate rehabilitation of the eye following resection of the facial nerve. 2) Be able to identify patients who would benefit from simultaneous gold weight placement at the time of major surgical resection. METHOD: We performed a retrospective review of patients who underwent immediate rehabilitation of the eye (gold weight and lateral tarsal strip) following facial nerve resection. From 1998-2009, 52 patients were studied. Postoperative and ophthalmologic complications, and the need for revision surgeries were measured. RESULTS: A gold weight was placed in all patients and 48/52 (92%) simultaneous lateral tarsal strips were performed. The facial nerve was sacrificed in 51/52 (88%) patients, and the remaining patient had a known preoperative facial nerve paralysis. 36/52 (69%) required free tissue transfer for reconstruction, underscoring the extensive resections performed. A 1.2 gram gold weight was placed in 49/52 (94%) of patients. Three (6%) patients required gold weight revision with a larger weight and three (6%) for extrusion 3/52. Nine (17%) patients underwent revision lateral tarsal strip for ectropion. CONCLUSION: No patients developed ophthalmologic complications. Patients undergoing radical surgical resections with known or suspected injury of the facial nerve should be considered for simultaneous rehabilitation of the upper and lower eye. Massive Facial Trauma Following IED Blasts in Operation Iraqi Freedom (OIF) Nathan Salinas, MD (presenter); Joseph Brennan, MD; Mark Gibbons, MD OBJECTIVE: Despite modern body armor, face, eye and brain injuries account for a significant percentage of improvised explosive device-related traumas sustained by United States military service members. Unlike maxillofacial injuries, eye and brain injuries usually require urgent evaluation and often

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